Pleural mesothelioma is a cancer that starts in the methoselial cells that line the pleura, a membrane covering the lungs and lining the chest cavity. This aggressive form of disease has struck 75% of all mesothelioma cases. Pleural mesothelioma is generally located on one side of the chest (unilateral), often occurring in men ages 60 to 80 who have a history of asbestos exposure. The disease begins with a series of tiny white nodules that spread on the pleural surface and gradually grow together thickly, forming a "rind" that surrounds the lungs and expands to the fissures of the pleura and the diaphragm. The manner that the tumor spreads is by invading the surrounding tissue, compressing the lung and invading the ribs and chest wall.

 

Pleural Mesothelioma Symptoms

On the early stage, symptoms of pleural mesothelioma are not alarming and often, they are attributed to old age or overwork. It may be several months after the onset of general symptoms that the first acute symptom, which is normally pleural effusion, occurs. There will also be evidences of shortness of breath due to the effusion or chest pain due to invasion of the chest wall and general symptoms such as dry cough, night sweats, fatigue and weight loss.

Pleural Mesothelioma Diagnosis

Initially, eighty to ninety percent of pleural mesothelioma patients have pleural effusion on X-ray; the remaining ten to twenty percent shows little or no fluid. At the beginning, the fluids are free-flowing and appear similar to those found in congestive heart failure or other benign causes. Due to this, other prospects are ruled out first in the process of diagnosis. The effusion later becomes "loculated" or contained inside a boundary within the pleural space where the fluid cannot move.
CT scans are definitive, showing not only the effusion, but also the existence of pleural masses and the size of lymph nodes. However, in determining the invasion of the chest wall and the spread of the disease in the diaphragm, MRI is more sensitive. And for staging pleural mesothelioma for possible surgery, PET may be helpful.
Pleural fluid analysis gives confirmed diagnosis in a small percentage of mesothelioma patients; needle biopsy gives only somewhat better results. Today, the most recommended procedure is the video-assisted thoracoscopy (VATS) because it yields more than 95% diagnosis and allows for drainage of fluids, pleural biopsy and pleurodesis. The procedure also provides sufficient tissue samples to come up with a definitive diagnosis.

Pleural Mesothelioma Staging

Staging plays an important role in determining the treatment options for pleural mesothelioma patients. There are several staging systems but the most commonly used and the most extensive is the TNM system which is associated with the International Mesothelioma Interest Group.

Pleural Mesothelioma Treatment

Many treatment alternatives are available for pleural mesothelioma such as surgery, radiotherapy, chemotherapy or trimodal therapy (a combination of the three), gene therapy, clinical trials, immunotherapy, etc. Inexperienced doctors might simply treat the symptoms with talc treatment and pleural effusion drainage. Mesothelioma specialists are more likely to recommend trimodal therapy. Second-line therapy usually involves chemotherapy.
Once a diagnosis is given, it is essential to discuss possible options among the doctor, patient and his family. Pleural mesothelioma remains a tough cancer to treat, but more awareness on the disease, new and improved diagnostics and more effective treatments all help to give it a better outlook.